RULES 


OF  THE 


Pennsylvania  Workmen's  Compensation  Board 


ISSUED    BY   THE 


WORKMEN'S  COMPENSATION  BUREAU 


OF  THE 


Department  of  Labor  and  Industry 
Harrisburg,  Pennsylvania 


Effective  January  1,  1920. 


THE  WORKMEN'S  COMPENSATION  BOARD 


HARRY  A.   MACKEY,   Chairman 
PAUL  W.   HOUCK 
BENJAMIN   3.   JARRETT 
CLIFFORD  B.   CONNELLEY,   Ex-Offlcio 


LEE   SOLOMON,    Secretary. 


HARRISBURG,  PENNA. : 
J.  L.  L.  KUHN,   PRINTER  TO  THE  COMMONWEALTH 

1919 


RULES 


OF  THE 


Pennsylvania  Workmen's  Compensation  Board 


ISSUED    BY   THE 


WORKMEN'S  COMPENSATION  BUREAU 


OF  THE 


Department  of  Labor  and  Industry 
Harrisburg,  Pennsylvania 


Effective  January  1,  1920. 


THE  WORKMEN'S  COMPENSATION  BOARD 

HARRY  A.   MACKEY,   Chairman 
PAUL  W.   HOUCK 
BENJAMIN   J.   JARRETT 
CLIFFORD  B.   CONNELLY,   Ex-Officio 


LEE   SOLOMON,    Secretary. 


HARRISBURG,  PENNA. : 
J.  L.  L.  KUHN,   PRINTER  TO  THE  COMMONWEALTH 

1919 


nW  r 


5^T 


<2) 


INDEX. 


AGREEMENTS :  Page. 

To  be  executed  by  dependents  in  case  of  deatb ,    8 

Supplemental,    8 

For  compensation  must  be  executed  when  disability  continues  for  more 

than  ten   days 7 

For  death,    . .- 8 

For  disability ,    7 

How  and  when  it  should  be  drawn ,    7 

By  minors , 9 

To  be  drawn  substantially  in  accordance  with  the  forms  of  the  Board,  11 

AMENDMENT : 

Disposition  of,  by  the  Board ,    12 

To  pleadings ,    12 

Of  the  record  substituting  the  State  Fund  for  the  employer,    13 

APPEALS : 

Bond  to  be  filed  under  certain  circumstances,    18 

By  either  party  from  the  action  of  the  Referee  on  a  petition,   when  as- 
signed to  him ,    17 

From  Referee  must  set  out  error  complained  of,   17 

How  to  be  heard ,    17 

Statements  to  be  contained  in  the  said  appeal,    17 

When  to  act  as  supersedeas,   18 

When  to  be  heard  by  the  Board 18 

BOARD : 

May  hear  petitions  for   review s    termination   or  modification,    or   refer 

the  same  to  a  Referee,   16 

BRIEFS  : 

When  to  be  filed ,    18 

CLAIM  PETITION  : 

Claim  petition  to  be  returned  to  claimant  when  necessary  information 

is  lacking 12 

COMMUTATION  : 

Petitions  for,    16 

COMPENSATION : 

How  the  day  of  its  first  payment  is  determined,    7 

COSTS : 

Bill  of  costs  to  filed  with  the  Secretary,    15 

Exceptions  %o  bill  of  cost  may  be  filed  within  three  (3)   days,    15 

Of  first  petition  to  be  paid  before  second  is  heard,    15 

Reasons  for  disposition  of  the  same  under  certain  circumstances  to  be 

set  out  by  Refen>e ,    , 15 

To  be  taxed  by  Referee  or  Board 15 

(3) 


DEATH :  Page. 

Agreements  for,    8 

Proof   of 8 

DISABILITY : 

Time  for  computing  when  the  same  becomes  compensable,    7 

DISTRICTS : 

Boundaries  and  designation  of 21 

EXCEPTIONS  : 

To  the  testimony  to  be  noted  by  the  Referee,   14 

FORMS : 

List  of,    18-19-20 

HEARINGS : 

By  the  Referee ,    14 

Shall  be  open  to  the  public,    14 

INVESTIGATION : 

By  referee  or  Inspector,    13 

Power  of  the  Referee  to  make,   14 

ISSUE: 

Of  fact  raised  by  petition  for  amendment  and  answer  to  be  heard  by  the 

Board  or  a  Referee  designated  by  the  Board 12 

MEDICAL  AND  HOSPITAL  SERVICES: 

To  be  recovered  by  claim  petition  filed  by  the  employe,   if  compensation 

agreement  fails  to  provide  for  same,    7 

NOTICES : 

To  be  sent  to  counsel,  insurance  carrier,   or  other  representatives  of  the 

party  in  interest ,    14 

OATHS : 

To  be  administered  by  Referee  and  clerks  without  charge,    12 

PETITIONS  : 

For  commutation,   contents  of,   method  of  hearing,    16 

For  commutation  may  be  referred  to  Referee  for  hearing,    16 

For  determination  of  compensation  due  under  agreed  facts,   forms  to  be 

used  and  statements  to  be  therein  contained,    16 

For  review,  termination  or  modification  of  agreement  or  award,    16 

Method  for  disposing  of  same,    16 

PLEADINGS  : 

Amendment  of,    12 

PHYSICIAN : 

How   appointed 13 

PRACTICE : 

By  a  Referee  when  petitions  have  been  referred  to  him ,    17 

Referee  shall  proceed  with  hearing  on  failure  of.  either  party  to  appeal 

when  proof  is  presented  that  notice  of  the  same  had  been  served,    ..         15 
Where  no  answer  is  filed  to  petition ,    17 


•      5 

i 

PROCEDURE :  Page. 

Before  Referee ,    13 

Rules  of,    11-12 

When  either  party  fails  to  appear  at  hearing,   14 

REFEREE : 

Assistance  to  be  given  by  to  unrepresented  parties,    14 

Duties  of,     13 

Duties  of,  upon  notice  of  appeal,    18 

Location  of,    and   district  assignments,    21 

HE-ASSIGNMENT : 

Of  petition  for  convenience,    13 

RECEIPTS : 

Final,   when  employe  refuses  to  sign,    8 

When  they  must  be  filed  with  the  Bureau,   7 

No  receipts  for  compensation  should  be  approved  unless  agreement  has 

been  previously  filed  and  approved,    7 

RE-MARRIAGE : 

Of  a  widow 9 

Where  widow  refuses  to  execute  supplemental  agreement,    9 

Supplemental  agreement  providing  for  changed  liability,    9 

RULES : 

For  ascertaining  wages,    10 

Of  procedure ,    11-12 

STATE  WORKMEN'S  INSURANCE  FUND : 

To  be  notified  when  it  is  the  insurer,    13 

SUPERSEDEAS : 

Filing  of  petition  to  terminate  or  modify  to  act  as 17 

SUPPLEMENTAL  AGREEMENTS : 

Effect  of,    8 

In  relation  to 8-i) 

Practice  when  employe  refuses  to  sign,   8 

When  employer  refuses  to  execute,    8 

TESTIMONY : 

To  be  taken  stenographically,    14 

WAGES : 

Rules  for  ascertaining,    10 

WITNESSES : 

To  receive  fair  and  courteous  treatment 14 


6 


All  persons  having  occasion  to  use  any  of  the  forms  may  obtain 
copies  of  the  same  by  applying  to  the  Workmen's  Compensation  Bu- 
reau, Department  of  Labor  and  Industry,  Harrisburg. 

January  1,  1920. 


RULES  AND  INSTRUCTIONS  FOR  THE  EXECUTION  OF  COM- 
PENSATION AGREEMENTS. 


1.     Agreements  for  Disability. 

No  agreement  is  necessary  unless  the  disability  resulting  from  the 
accidents  lasts  more  than  ten  days.  If  the  employer  has  failed  to 
provide  the  surgical,  medical  and  hospital  services  required  by  the 
Act  the  employe  may  file  a  claim  petition  for  such  expenses. 

In  computing  the  time  when  the  disability  becomes  compensable, 
the  day  upon  which  the  accident  happens  is  to  be  considered  one  of 
the  ten  days.  Thus,  if  an  accident  occurs  at  any  hour  on  January  1, 
the  right  to  compensation  begins  on  January  11. 

Compensation  agreements,  as  provided  by  the  Act,  must  be  executed 
(substantially  as  provided  in  Form  W  14)  whenever  the  disability 
continues  for  more  than  ten  days.  No  receipt  for  compensation  from 
an  employe  will  be  approved  as  a  discharge  of  the  liability  created  by 
Article  III,  unless  an  agreement  for  compensation  has  been  mailed 
or  delivered  to  the  Board  and  approved  by  it.  Receipts  for  compen- 
sation payments  must  be  filed  with  the  Bureau  at  least  quarterly  in 
all  cases  where  disability  continues  for  a  period  of  more  than  three 
months.  A  final  receipt  with  suffice  in  cases  in  which  disability  is 
less  than  three  months'  duration. 

When  the  accident  has  caused  the  loss  of  a  hand,  foot,  arm,  leg 
or  eye  or  the  use  thereof,  an  agreement  should  be  made,  immediately 
after  the  expiration  of  the  first  ten  days,  for  the  payment  of  com- 
pensation for  the  number  of  weeks  appropriate  to  the  particular  dis- 
memberment. 

When  the  disability  is  one  of  uncertain  duration,  an  agreement 
should  be  made  not  more  than  three  weeks  after  the  disability  begins. 
This  agreement  should  provide  that  compensation  be  paid  during 
the  full  "500  weeks,"  when  the  disability  is  total,  or  "300  weeks," 
when  it  is  partial  "or  until  this  agreement  has  been  terminated  by 
supplemental  agreement  or  final  receipts  approved  by  the  Workmen's 
Compensation  Board  or  by  the  order  of  the  Board."  The  agreement 
must  state  the  amount  of  compensation  payable  weekly  and  the  total 
amount  payable  under  it,  which  is  the  weekly  compensation  multi- 
plied by  the  number  of  weeks  (500  or  300)  during  which  compen- 
sation is  payable. 


A  supplemental  agreement  (substantially  as  provided  in  Form  No. 
14a)  modifying  the  agreement  or  award,  should  be  executed,  if  the 
employe's  {Usability  changes  from  total  to  partial,  by  his  regaining 
his  ability  to  work,  though  at  a  reduced  earning  power,  or  from 
partial  to  total,  where  an  injury,  which  had  originally  reduced  his 
earning  power,  increases  so  as  to  completely  destroy  it.  If  the  em- 
ploye recovers  from  his  injury  so  as  to  regain  his  full  earning  power, 
which  is  generally  known  by  his  return  to  work  at  his  original  wages, 
a  supplemental  agreement  (substantially  as  provided  in  Form  W 
14a)  may  be  executed  or  final  receipts  (substantially  as  provided 
in  Form  W  51b),  setting  forth  the  manner  in  which  and  the  date  on 
which  the  employe's  disability  terminated  and  signed  by  him  in  the 
presence  of  an  .attesting  witness,  may  be  filed  with  the  Workmen's 
Compensation  Bureau  at  Harrisburg. 

If  the  employe  refuses  to  execute  such  a  supplemental  agreement 
or  sign  such  final  receipts,  when  his  disability  has  diminished  or 
ceased,  or  if  the  employer  should  refuse  to  execute  such  an  agreement 
when  the  employe's  disability  has  increased,  a  petition  can  be  pre- 
sented to  the  Board  (substantially  as  provided  in  Form  W35), 
praying  it  to  order  the  agreement  or  award  modified  or  terminated. 

The  filing  of  such  a  petition  will  suspend,  until  the  petition  be 
granted  or  refused,  the  payment  of  compensation  to  such  an  extent 
as  the  facts  alleged  therein  would,  if  proved,  require. 

If  any  employe,  entitled  to  compensation  for  disability,  under  an 
agreement  or  award,  dies  as  a  result  of  his  injury,  leaving  dependent 
or  dependents,  an  agreement  (substantially  as  provided  in  Form  W- 
15)  should  be  made  with  the  dependent  or  dependents  of  the  employe. 
Such  an  agreement  stating,  as  it  must,  the  date  of  the  employe's 
death,  will  of  its  own  force  and  without  any  further  agreement,  termi- 
nate the  disability  agreement  as  of  the  date  of  such  death. 

Should  there  be  no  dependents  of  such  an  employe  the  Board  will 
accept  as  prima  facie  proof  of  the  termination  of  liability  under  an 
agreement  or  award  a  certified  copy  of  the  death  certificate  of  such 
employe  together  with  the  last  receipt  signed  by  him. 

II.     AGREEMENTS  FOR  DEATH  COMPENSATION. 

When  the  accident  causes  death,  an  agreement  (substantially  as 
provided  in  Form  W  15)  should  be  executed  between  the  employer 
and  the  dependent,  dependents  or  personal  representative. 

Wherever  the  liability  of  an  employer  for  death  compensation  under 
an  agreement  or  award  has  been  terminated  by  the  marriage  of  a 
w  idow,  there  being  no  child  entitled  to  compensation,  or  by  the  death 
of  all  the  dependents,  a  supplemental  agreement  (substantially  as 
provided  in  Form  W  15)  terminating  the  compensation  agreement  or 


9 

the  award  may  be  executed  or  receipts  (substantially  as  provided  in 
Form  W  15c)  setting  forth  the  manner  in  which  and  the  date  on  which 
the  dependency  of  the  person  or  persons  entitled  ceased  and  signed 
by  the  widow,  guardian  of  the  dependent  child  or  children,  or  brother 
or  sister  or  by  the  personal  representative  of  the  father  or  mother, 
in  the  presence  of  an  attesting  witness,  shall  be  filed  with  the  Work- 
men's Compensation  Bureau  at  Harrisburg. 

Where  the  marriage  of  a  widow  or  the  death  of  a  dependent  changes 
the  amount  of  compensation  of  the  person  or  persons  to  whom  it  is 
payable,  but  does  not  entirely  extinguish  the  employer's  liability 
under  an  award  or  agreement,  a  supplemental  agreement  (substan- 
tially as  in  Form  W  15a)  should  be  executed. 

If  the  widow  upon  marriage,  or  the  remaining  dependents,  where 
there  were  several  dependents  and  one  dies,  shall  refuse  to  execute 
such  a  supplemental  agreement  or  sign  such  a  receipt  as  the  facts 
require,  a  petition  may  be  presented  to  the  Board  praying  it  to 
modify  or  terminate  the  compensation  agreement  or  award,  and  the 
filing  of  such  a  petition  will,  until  the  petition  be  granted  or  re- 
fused, suspend  the  payment  of  compensation  to  such  an  extent  as  the 
facts  alleged  therein  would,  if  proved,  require. 

Where  an  agreement  or  award  is  made  in  favor  of  a  single  depend- 
ent and  such  dependent  dies,  the  Board  will  accept  as  prima  facie 
proof  of  the  termination  of  the  liability  under  such  agreement  or 
award  a  certified  copy  of  the  death  certificate  of  such  dependent 
together  with  the  last  receipts  signed  by  him  or  her. 


AGREEMENTS  BY  EMPLOYES  AND  DEPENDENTS  UNDER 

THE  AGE  OF  TWENTY-ONE. 


All  agreements,  supplemental  agreements  and  receipts  executed  by 
an  employe  of  whatever  age  or  by  a  dependent  over  the  age  of  sixteen 
shall  be  as  valid  and  binding  as  though  such  employe  or  dependent 
were  over  the  usual  legal  age  of  twenty-one.  The  signature  of  the 
guardian  is  therefore  only  necessary  where  the  sole  dependents  are 
children  below  the  age  of  sixteen  years. 


10 


EULES  FOE  ASCEETAINING  WAGES. 


The  compensation  under  Sections  306  and  307  (as  amended)  is  a 
slated  percentage  of  the  employe's  weekly  wages.  It  is  therefore 
necessary  in  every  case  to  ascertain  the  weekly  wages  of  the  employe. 

Section  309  (as  amended)  defines  wages  as  "the  money  rate  at 
which  the  service  is  recompensed  under  the  contract  for  hiring  in 
force  at  the  time  of  the  accident." 

To  ascertain  the  wages,  add  to  the  sum  agreed  to  be  paid  the  value 
of  any  board  and  lodging  supplied  by  the  employer. 

(a)  If  the  value  of  the  board  and  lodging  is  fixed  by  the  contract 
of  hiring,  add  the  value  so  fixed. 

(b)l  If  no  value  is  put  upon  the  board  and  lodging  by  the  contract 
of  hiring,  add  50  cents  per  day  for  board  and  50  cents  per  day  for 
lodging. 

But  do  not  add  any  gratuities  given  the  employe  by  the  employer 
or  other,  such  as  tips  or  presents. 

Deduct  from  the  sum  agreed  to  be  paid  for  the  employe's  services, 
any  amounts,  deducted  by  the  employer  for  labor  furnished  or  paid 
for  by  the  employer  and  necessary  for  the  performance  of  the  em- 
ploye's contract  of  employment. 

But  do  not  deduct: 

1.  Amounts  earned  as  over-time. 

2.  The  value  of  materials,  supplies,  tools  and  other  things  neces- 
sary for  the  performance  of  the  employe's  contract  of  employment, 
through  furnished  by  the  employer  and  charged  against  the  employe's 
earnings. 

3.  Any  sums  due  the  employer  for  rent  or  supplies  other  than 
those  necessary  for  the  employe's  use  in  the  performance  of  his  labor, 
even  though  supplied  by  the  employer  under  a  contract  which  gives 
him  the  right  io  deduct  such  sums,  from  the  wages  from  time  to  time 
due  the  employe. 

When  the  wages  at  the  time  of  the  accident  are  fixed  by  the  week, 
the  weekly  wage  so  fixed  shall  be  the  basis  for  computing  compensa- 
tion. 

When  the  wages  are  fixed  on  a  monthly  basis,  ascertain  the  weekly 
wages  by  multiplying  the  monthly  salary  or  wages  by  12  and  dividing 
by  52. 

When  the  wages  are  fixed  by  the  year,  divide  the  yearly  wage  by 
52. 


11 

Where  in  a  continuous  employment  the  rate  of  wages  is  fixed  'by 
the  day,  hour  or  by  the  output  of  the  employe,  multiply  by  five  and 
one-half,  the  employe's  average  earnings,  at  such  rate  for  a  working 
day,  unless  the  employe  customarily  worked  more  than  5£  days  a 
week  in  which  case  multiply  by  the  number  of  days  customarily 
worked  per  week. 

To  find  "average  earnings  for  a  working  day" — take  total  earnings 
for  six  months  preceding  the  accident,  or  so  much  thereof  as  employe 
has  worked  for  the  same  employer  and  divide  such  total  earnings  by 
the  number  of  'working  days'  in  such  period. 

"Working  Days"  shall  be  construed  to  mean  total  number  of  days 
in  the  period  of  employment  covered,  according  to  the  calendar,  less: 

(a)  Sundays  f  unless  the  employe 

(b)  Legal  Holidays 

(c)  Half  holiday  for  each  week 

(d)  Days  employe  was  prevented  from 

working  through  no  fault  of 
his  own. 


actually  worked  on 
L  such  days. 


Section  309  (as  amended)  makes  very  clear  and  definite  provisions 
for  the  exceptional  cases  where  the  employment  is  seasonal  or  where 
by  reason  of  the  short  time  which  elapses  between  the  hiring  and  the 
accident,  the  earnings  of  the  employe  to  not  furnish  a  satisfactory 
basis  for  computing  his  wages  or  where  an  employe  prior  to  the 
accident  has  been  working  for  two  or  more  employers  under  con- 
current contracts  of  employment. 


RULES  OF  PROCEDURE. 


1.  All  agreements,  petitions  and  answers  must  be  substantially 
in  accordance  with  the  forms  prepared  by  the  Board. 

2.  If  the  facts  agreed  upon  in  a  compensation  agreement  differ 
materially  from  the  facts  stated  in  the  report  of  the  accident  and 
reports  supplemental  thereto  made  to  the  Department  of  Labor  and 
Industry,  the  agreement  will  not  be  approved  until  the  discrepancy 
is  explained  to  the  satisfaction  of  the  Board. 


12 

3.  Any  petition  which  does  not  contain  the  information  required 
by  Forms  W  L8  and  W  1!>,  will  not  be  assigned  to  a  Referee  for  hear- 
ing, but  will  be  returned  to  the  claimant  inorder  that  he  may  supply 
the  information  not  given. 

4.  Compensation  Referees  and  their  clerks  shall  administer  oaths 
free  of  charge  and  shall,  when  requested  to  do  so,  assist  any  party  in 
drawing  a  claim  petition,  answer  or  any  other  paper  necessary  for 
the  administration  of  the  Workmen's  Compensation  Act. 


AMENDMENT  OF  PLEADINGS. 


1.  Any  petition,  answer,  appeal  or  other  pleading  in  any  matter 
pending  before  the  Board  may  be  amended  before  final  action  by  the 
Board  by  a  written  agreement  or  by  a  petition  filed  with  the  Secre- 
tary of  the  Board  at  the  principal  office  at  Harrisburg. 

2.  Any  petition  which  has  been  assigned  by  the  Board  to  a  Re- 
feree, any  answer  thereto,  or  other  pleading  therein  may  be  amended 
prior  to  an  award  or  disallowance  by  the  Referee  by  written  agree- 
ment or  by  petition  filed  with  the  Referee  at  his  office. 

3.  A  copy  of  such  petition  to  the  Board  or  Referee  must  be  served 
by  registered  mail  upon  each  adverse  party  or  his  counsel.  The 
petition  must  set  forth  under  affidavit  the  original  pleading,  the 
amended  pleading  desired,  the  reasons  why  the  amendment  is  desired 
and  such  facts  as  are  alleged  as  grounds  for  amendment  and  the  date 
of  mailing  the  copy  of  the  petition  to  each  adverse  party. 

4.  Any  adverse  party  may,  within  six  days  after  the  copy  of  the 
petition  is  mailed  to  him,  file  an  answer  under  affidavit  denying  any 
fact  alleged  in  the  petition  and  giving  any  other  reason  wThy  the 
amendment  prayed  therein  should  not  be  granted. 

5.  The  petition  will  be  disposed  of  by  the  Board  or  Referee  with- 
out argument. 

6.  Any  issue  of  fact  raised  by  a  petition  for  amendment  and 
answer  thereto,  filed  with  the  Secretary  of  the  Board,  may  be  heard 
by  the  Board  or  referred  to  any  Referee,  whose  finding  therein  shall 
be  final. 


13 


PROCEDURE  BEFORE  REFEREES. 
DUTIES  OF  A  REFEREE  BEFORE  A  HEARING. 


1.  When  a  claim  petition  is  assigned  to  a  Referee,  he  should  en- 
deavor to  bring  the  parties  to  an  understanding  and  to  induce  them 
to  settle  the  claim,  without  further  litigation,  by  an  appropriate 
compensation  agreement. 

2.  The  Referee  may  continue  the  hearing  and  make  an  investiga- 
tion either  in  person  or  through  an  inspector  of  the  Department  of 
Labor  and  Industry,  when  in  his  judgment  such  an  investigation  is 
necessary  to  determine  any  question  of  fact  raised  by  the  pleadings 
or  testimony  or  when  there  is  a  discrepancy  between  the  facts  set 
forth  in  the  claim  petition  and  those  stated  in  the  reports  of  the 
accident  made  to  the  Department  of  Labor  and  Industry. 

3.  Where  any  medical  fact  is  put  in  issue  by  a  petition  and  answer 
the  Referee  may  with  the  consent  of  the  Board  appoint  an  impartial 
physician  or  physicians  to  examine  the  physical  condition  of  the  peti- 
tioner or  defendant  to  the  petition  and  report  thereon. 

4.  When  a  claim  petition  has  been  assigned  to  a  Referee  and  the 
only  fact  denied  in  the  answer  is  one  which  can  be  more  conveniently 
investigated  in  another  compensation  district,  the  petition  may  be 
assigned  to  the  Referee  of  such  other  district. 

5.  WThen  one  of  the  allegations  denied  in  an  answer  to  a  claim 
petition  is  the  disability  of  an  employe  or  the  status  of  a  dependent, 
this  question  may  be  referred  through  the  Bureau  by  the  Referee  to 
whom  the  petition  is  assigned,  to  the  Referee  of  any  district  in  which 
the  question  can  be  more  conveniently  investigated,  whose  finding 
thereon  when  made  to  the  original  Referee  shall  be  of  the  same  effect 
as  a  finding  of  the  original  Referee. 

6.  When  it  comes  to  the  notice  of  any  Referee  to  whom  a  claim 
petition  has  been  assigned  whether  before,  at  or  after  hearing  held 
thereon  that  the  State  Workmen's  Insurance  Fund  is  the  insurance 
carrier  of  the  employer  defendant,  the  Referee  shall  stay  all  pro- 
ceedings and  continue  any  hearing  set  or  held  and  shall  immediately 
notify  the  State  Workmen's  Insurance  Fund  at  its  principal  office 
at  Harrisburg. 

Upon  receipt  of  a  notification  from  the  State  Fund  that  the  em- 
ployer against  whom  the  petition  has  been  filed  has  notified  the 
fund  of  the  accident,  as  required  by  Section  20  of  the  Act  creating 
the  State  Fund,  the  Referee  shall  amend  the  record  in  the  case  so  as 
to  make  the  State  Fund   the  defendant  instead  of  the  employer. 


14 

When  the  Referee  files  his  award  or  disallowance  with  the  Bureau, 
he  shall  notify  the  Bureau  that  he  has  amended  the  record  as  afore- 
said,  so  as  to  enable  the  Bureau  to  amend  its  record  accordingly. 

7.  When  any  counsel,  insurance  carrier  or  representative  of  any 
party  in  interest  shall  have  filed  his  appearance  in  writing  the  Re- 
feree shall  sorve  all  notices  and  other  papers  upon  him  and  not  upon 
the  party  whom  he  represents,  and  shall  return  the  appearance  as 
part  of  the  record  to  the  Bureau  with  his  award  or  disallowance  of 
compensation. 


HEARINGS. 


1.  The  Referee  shall  hold  a  hearing  at  the  place,  within  his  dis- 
trict, most  convenient  to  all  parties  concerned. 

2.  All  hearings  before  the  Board  or  a  Referee  shall  be  open  to  the 
public. 

3.  The  Referee  shall  cause  the  testimony  produced  at  the  hearing 
to  be  taken  stenographically.  Whenever  the  question  of  admissibility 
of  testimony  is  presented  for  the  consideration  of  the  Referee  he  shall 
promptly  rule  upon  the  same  and  note  an  exception  to  either  party 
tequesting  it. 

4.  The  Referee  shall  require  that  both  parties  and  counsel  shall 
treat  all  witnesses  fairly  and  courteously. 

5.  WThen  either  a  claimant  or  defendant  is  not  represented  by 
counsel,  the  Refciee  shall  advise  him  as  to  his  rights,  aid  him  in  ex- 
amining witnesses  and  give  him  all  assistance  which  is  compatible 
with  the  judicial  position  of  the  Referee. 

In  all  cases  when  the  defendant  shall  fail  to  file  an  answer  the 
Referee  shall  have  the  same  power  to  make  an  investigation  in  person 
or  by  physicians  or  experts  as  through  an  answer  has  been  filed. 


PROCEDURE,  WHEN  EITHER  PARTY  FAILS  TO  APPEAR  AT 

HEARING. 


Where  a  claimant  fails  to  appear  at  a  hearing  set  by  a  Referee  of 
which  he  or  his  counsel  of  record  has  received  timely  notice  and  does 
not  file  with  the  Referee  before  or  at  the  hearing  a  legal  excuse  for 


15 

his  non-appearence,  the  Referee  shall  dismiss  the  petition  without 
prejudice  to  the  right  of  the  claimant  to  file  a  second  petition  at  any 
time  within  the  period  of  limitation. 

If  a  second  petition  is  filed,  it  will  not  be  assigned  to  any  Referee 
until  the  claimant  has  satisfied  the  Board  that  he  has  paid  the  costs 
incurred  in  the  first  proceedings  as  taxed  by  the  Board. 

If  a  defendant  shall  fail  to  appear  at  a  hearing  set  by  the  Referee, 
of  which  such  defendant  or  his  insurance  carrier  or  counsel  of  record 
has  had  timely  notice,  the  Referee  shall  proceed  with  the  hearing. 


COSTS. 


Costs  incurred  by  a  party  will  not  be  included  in  an  award  unless 
the  part  shall,  within  three  days  after  final  hearing,  file  with  the  Ref- 
eree or  with  the  Secretary  of  the  Workmen's  Compensation  Board, 
if  the  case  is  heard  by  the  Board,  an  itemized  statement  of  the  costs, 
giving  the  names  of  witnesses,  days  of  actual  attendance,  mileage,  ser- 
vice of  subpenas,  and  shall  verify  the  same  by  affidavit  that  the  wit- 
nesses named  were  material  and  in  actual  attendance  at  the  time 
specified  and  shall  serve  a  copy  thereof  by  mail  upon  the  adverse 
party  or  his  council  or  insurance  carrier. 

The  adverse  party  may  within  three  days  after  such  copy  has 
been  served  upon  him  file  exceptions  thereto  with  the  Referee  or  with 
the  Secretary  of  the  Board,  as  the  case  may  be,  and  the  Referee  or 
Board  shall  fix  a  time  and  place  for  hearing  the  same. 

The  Referee  or  Board,  as  the  case  may  be,  shall  tax  the  costs  in- 
curred by  the  parties  as  shown  by  the  itemized  statement  filed  by 
them  and  shall  place  such  costs  as  are  allowed  by  him  together  with 
those  incurred  by  the  Referee,  upon  the  unsuccessful  party,  unless  the 
special  circumstances  of  the  case  make  it  proper  to  otherwise  dispose 
of  them.  In  such  case  he  may  put  upon  each  party  the  costs  incur- 
red by  him  or  he  may  divide  the  costs  in  such  proportion  as  he  shall 
deem  proper.  If  the  Referee  shall  dispose  of  the  costs  otherwise 
than  by  imposing  them  upon  the  unsuccessful  party,  he  shall  set  forth 
fully  in  his  award  his  reasons  for  so  doing. 

The  costs  of  the  hearing  shall  be  paid  to  the  Referee  or  Secretary 
and  shall  be  paid  over  by  him  to  the  parties  entitled  thereto,  unless 
the  party  on  whose  behalf  the  costs  have  been  incurred  shall  present 
receipts  from  the  parties  entitled  thereto,  in  which  case  the  costs  so 
paid  by  the  party  shall  be  paid  to  him. 


10 


PETITIONS  TO  THE  BOARD. 


PETITION  FOR  DETERMINATION  OF  COMPENSATION  DUE 

UNDER  AGREED  FACTS. 

Petitions  to  the  Board  praying  for  the  determination  of  compensa- 
tion due  under  facts  agreed  upon  by  the  parties  shall  state  whether 
the  parties  desire  the  case  to  be  determined : 

i  a  )     Without  argument. 

(b)  On  briefs  submitted  or, 

(c)  On  oral  or  written  argument  in  person  or  by  counsel. 


PETITIONS  FOR  COMMUTATION. 


Compensation  can  only  be  commuted  by  an  order  of  the  Board  and 
all  petitions  for  commutation  must  be  therefore  determined  by  the 
Board. 

Every  petition  for  commutation  must  contain  a  full  detailed  state- 
ment of  the  circumstances  which  are  alleged  to  require  the  commuta- 
tion and  must  be  sworn  to  by  the  petitioner  and  filed  with  the  Secre- 
tary of  the  Board. 

The  Board  may  either  itself  investigate  the  facts  or  may  refer  the 
petition  to  a  Referee  to  hear  the  facts  and  reports  his  findings  there- 
on to  the  Board.  The  petitioner  must  appear  in  person'  unless  his 
need  is  urgent  or  illness  or  other  'sufficient  cause  prevent  his  appear- 
ance before  the  Board  or  Referee,  at  the  hearing  held  to  ascertain  the 
facts. 


PETITIONS  FOR  REVIEW  OF  AGREEMENT  OR  THE  TERMI- 
NATION OR  MODIFICATION  OF  AGREEMENT  OR  AWARDS. 


All  petitions  for  the  review  of  an  agreement,  or  for  the  termination 
or  modification  of  an  agreement  or  award  will  be  disposed  of  as  fol- 
lows: 


17 

1.  The  Board  may, 

(a)  Order  the  case  heard  by  the  Board  itself  on  evidence  to  be 
taken  before  it. 

(b)  It  may  order  the  petition  to  be  heard  and  determined  by  the 
Board  itself  but  may  refer  the  petition  to  a  referee  to  take  testimony 
and  report  to  the  Board  his  findings  of  fact  thereon. 

(c)  The  Board  may  assign  the  case  to  a  referee  to  be  heard  and 
determined  by  him. 

2.  If  no  answer  is  filed  within  ten  days  after  the  notice  of  the  pe- 
tition has  been  served  on  all  adverse  parties,  the  Board  or  the  Referee, 
if  the  petition  has  been  assigned  to  a  Referee  for  determination,  will 
dispose  of  the  matter  upon  the  facts  alleged  in  the  petition. 

3.  The  Referee  shall  fix  a  time  and  place  for  the  hearing  and  shall 
notify  all  parties  thereof  and  shall  hear  and  determine  the  matter,  and 
return  his  findings  to  the  Bureau  in  the  same  manner  as  in  the  case 
of  a  claim  petition. 

4.  A  party  against  whom  the  Referee  has  made  a  finding  may  ap- 
peal to  the  Board  on  the  same  grounds  and  in  the  same  manner  as  in 
1he  case  of  an  appeal  from  a  Referee's  award  or  disallowance  of  com- 
pensation. 

5.  The  filing  of  a  petition  to  terminate  or  modify  a  compensation 
agreement  or  award,  will  operate  as  a  supersedeas  and  will  suspend 
the  payment  of  compensation  fixed  in  the  agreement  or  by  the  award, 
in  whole  of  in  such  parties  as  the  facts  alleged  in  the  petition,  would 
if  proved,  require. 


APPEALS  FROM  REFEREES. 


1.  When  the  appeal  is  taken  from  the  decision  of  a  Referee  on 
questions  of  fact  or  law,  the  appellant  must  set  forth  specifically  on 
and  fully  the  errors  of  which  he  complains,  and  shall  specify  whether 
he  desires  the  case  to  be  heard: 

(a)  Without  argument. 

(b)  On  briefs  submitted,  or 

(c)  On  oral  argument  in  person  or  by  counsel. 

2.  Appeals  must  be  filed  in  duplicate. 

:j.  Appeals  sluill  Ite  heard  without  the  parties  appearing  in  person 
or  by  counsel  unless  the  appellant  shall  at  the  time  of  filing  his  appeal 
notify  the  Board  thai   he  desires  to  appear  in  person  or  by  counsel, 


IS 

or  the  apellee  shall  within  five  days  after  notice  of  the  appeal  has 
been  served  upon  him  notify  the  Board  that  he  desires  to  appear  in 
person  or  by  counsel. 

4.  If  neither  party  has  notified  the  Board  of  his  desire  to  appear 
ii.  person  or  by  counsel,  the  Board  will  consider  the  appeal  at  the 
next  meeting  or  sitting  held  by  it  after  the  expiration  of  ten  days 
from  the  date  of  service  of  notice  or  appeal  upon  the  appellee. 

5.  The  appellant  or  appellee  may  file  a  written  brief  at  or  prior  to 
the  time  his  appeal  is  heard.    All  briefs  shall  be  filed  in  triplicate. 

6.  An  appeal  taken  by  the  State  Workmen's  Insurance  Fund  or 
by  an  employer,  who  has  complied  with  Section  305,  will  operate  as 
a  supersedeas  and  will  suspend  the  payments  ordered  by  the  award 
appealed  from,  in  whole  or  in  such  part  as  the  appeal,  if  sustained, 
would  require.  An  appeal  by  an  employer  who  has  not  complied 
with  Section  305,  will  not  operate  as  a  supersedeas,  unless  such  em- 
ployer shall  file  a  satisfactory  bond  in  an  amount  sufficient  to  secure 
the  payment  of  the  compensation,  due  under  the  award  at  the  date 
ot  the  appeal  and  the  compensation  which  may  accrue  during  the 
pendency  of  the  appeal. 

7.  Whenever  the  Referee  shall  receive  notice  from  the  Bureau 
that  an  appeal  has  been  filed  with  the  Board  from  his  decision  in 
any  case,  he  shall  immediately  cause  the  notes  of  testimony  taken 
iii  that  case  to  be  typewritten  and  forward  to  the  Board  a  copy  with 
the  certificate  of  the  official  stenographer  that  they  are  full  and  cor- 
rect. 


LIST  OF  FORMS  FOR  PUBLIC  USE. 


Form  W  1  —Employer's  Notice  to  his  Employe  of  his  Rejection  of 
Article  III  of  the  Workmen's  Compensation  Act  of  1915. 

Form  W  2  — Notice  to  Laborers  and  Assistants  not  directly  em- 
ployed by  the  Principal  Employer  of  his  Rejection  of 
Article  III  of  the  Workmen's  Compensation  Act  of 
1915. 

Form  W  3  — Notice  to  Employer  or  Employe  of  Laborer's  Re- 
jection of  Article  III  of  the  Workmen's  Compensation 
Act  of  1915. 

Form  W  4  — Employer's  Notice  of  Termination  of  Rejection  or  Ac- 
ceptance of  Article  III  of  the  Workmen's  Compensation 
Act  of  1915. 


19 

Form  W  5  — Employer's  Notice  to  Laborers  and  Assistants  of 
Termination  of  Kejection  or  Acceptance  of  Article  III  of 
the  Workmen's  Compensation  Act  of  1915. 

Form  W  6  — Employe's  Notice  of  Termination  of  Rejection  or  Ac- 
ceptance of  Article  III  of  the  Workmen's  Compensation 
Act  of  1915. 

Form  W  7  — Proof  of  Service  of  Employer's  Notice  of  his  Rejec- 
tion or  Termination  of  his  Rejection  or  Acceptance  of 
Article  III  of  the  Workmen's  Compensation  Act  of  1915. 

Form  W  7  a  — Proof  of  service  of  Employer's  Notice  to  his  Employes 
in  Manner  Permitted  by  Special  Order  of  the  Board. 

Form  W  8  — Proof  of  Posting  Notice  to  Laborers  and  Assistants 
hired  by  an  Employe  or  Contractor  of  the  Principal  Em- 
ployer's Rejection  or  Termination  of  his  Rejection  of 
Acceptance  of  Article  III  of  the  Workmen's  Compen- 
sation Act  of  1915. 

Form  W  9  — Notice  of  Proof  of  Service  of  Employe's  Rejection  or 
Termination  of  his  Rejection  or  Acceptance  of  Article 
III  of  the  Workmen's  Compensation  Act  of  1915. 

Form  W  10  — Employer's  Application  for  the  Privilege  of  Paying 
Compensation  Provided  iu  Article  III  of  the  Workmen's 
Compensation  Act  of  1915,  without  Insurance. 

Form  W  14  — Agreement  for  Compensation  for  Disability. 

Form  W  14  a — Supplemental  Agreement  for  Termination  or  Modifi- 
cation of  a  Compensation  Agreement  or  Award  for  Dis- 
ability. 

Form  W  15  — Agreement  for  Compensation  for  Death. 

Form  W  15  a — Supplemental  Agreement  Terminating  or  Modifying 
an  Agreement  as  to  or  an  Award  of  Compensation  for 
Death. 

Form  W  18  — Employe's  Claim  Petition  for  Compensation  for  Disa- 
bility. 

Form  W  19  — Claim  Petition  for  Compensation  by  Dependents  of 
Deceased  Employe. 

Form  W  25  — Appeal  from  Referee  Alleging  Error  of  Law. 

Form  W  26  — Appeal  from  Referee's  Findings  of  Fact. 


20 

Form  W  27  — Appeal  from  Keferee  on  the  Ground  of  Fraud,  Coer- 
cion, or  other  Improper  Conduct  of  a  Party  in  Interest. 

Form  W  30  — Petition  to  the  Board  for  the  Determination  of  Com- 
pensation for  Disability  under  Facts  agreed  upon  by  the 
Parties. 

Forin  W  31  — Petition  to  the  Workmen's  Compensation  Board  to 
Determine  the  Compensation  Payable  under  Agreed 
Facts  to  the  Dependents  of  Deceased  Employe. 

Form  W  32  — Petition  for  Keview  of  Compensation  Agreement. 

Form  W  33  — Petition  by  Employer  for  Commutation  of  Compen- 
sation. 

Form  W  34  —Petition  by  Employe  or  Dependents  for  Commutation 
of  Compensation. 

Foim  W  35  — Petition  for  Termination  or  Modification  of  Agree- 
ment or  Award  on  Ground  of  Changed  Disability. 

Form  TV  36  — Petition  by  Employer  for  Modification  or  Termination 
of  a  Compensation  Agreement  or  Award  on  the  Ground 
of  change  in  the  Status  of  the  Dependent  or  Dependents 
of  a  Deceased  Employe. 

I'orm  TV  38  — Answer  to  Petition  for  the  Review  of  a  Compensation 
Agreement. 

Form  TV  39  — Answer  to  Petition  for  the  Commutation  of  Compen- 
sation Payable  under  an  Agreement  or  Award. 

Form  TV  40  — Answer  to  Petition  for  the  Modification  or  Termina- 
tion of  a  Compensation  Agreement  or  Award. 

Form  TV  47  — Petition  of  Employer  for  Physical  Examination  of 
Employe. 

Form  TV  49  — Petition  of  Employer  for  Further  Physical  Examina- 
tion of  Employe. 

Form  W51  — Receipt  of  Compensation  Paid  under  a  Compensation 
Agreement  or  Claim  Petition. 

I'orm  TV  51  b— Final  Receipt  for  Disability  Paid  under  -a  Compen 
sation  Agreement  or  Claim  Petition. 

Foim  TV  51  c— Final  Receipt  for  Death  Paid  under  a  Compensation 
Agreement  or  Claim  Petition. 


21 


WORKMEN'S  COMPENSATION  DISTRICTS. 


District  No.  1  — Bucks,  Chester,  Delaware,  Montgomery  and  Phila- 
delphia Counties.  Referees:  Warren  C.  Graham. 
Charles  W.  Rosier,  North  American  Ruilding,  Broad 
and  Sansom  Sts.,  Philadelphia. 

— Berks,  Carbon,  Lehigh,  Northampton  and  Schuyl- 
kill Counties.  Referee:  Thomas  C.  Seidel,  Uliner 
Building,  207  N.  Center  St.,  Pottsville. 


District  No.  2 


District  No.  3 


District  No.  4 


District  No.  5 


— Lackawanna,  Luzerne,  Monroe,  Pike,  Susquehanna, 
Wayne  and  Wyoming  Counties.  Referee:  George  W. 
Beemer,  Union  National  Bank  Building,  Lackawan- 
na and  Washington  Avenues,  Scranton. 

— Adams,  Cumberland,  Dauphin,  Franklin,  Fulton, 
Juniata,  Lancaster,  Lebanon,  Perry  and  York  Coun- 
ties. Referee:  Chester  W.  Cummings,  Woolworth 
Building,  Grant  and  Queen  Sts.,  Lancaster. 

— Bradford,  Cameron,  Centre,  Clinton,  Columbia, 
Lycoming,  Mifflin,  Montour,  Northumberland,  Pot- 
ter, Snyder,  Sullivan.  Tioga  and  Union  Counties. 
Referee:  W.  W.  Champion,  First  National  Bank 
Building,  21  W.  3rd  St.,  Williamsport. 

— Bedford,  Blair,  Cambria,  Clearfield,  Huntingdon, 
Indiana,  Jefferson  and  Somerset  Counties.  Referee: 
Jacob  Snyder,  Commerce  Building,  1434-36  Eleventh 
Ave.,  Altoona. 

District  No.  7.     —Armstrong,  Clarion,  Crawford,  Elk.  Erie,  Forest. 

McKean,    Mercer,   Venango    and   Warren    Counties. 

Referee:  G.  Scott  Smith,  216-20  Second  St..  Warren. 

District  No.  8    —Allegheny,  Beaver,  Butler,  Fayette,  Greene,  Law- 
rence, Washington  and  Westmoreland  Counties.  Ref- 
erees: L.  E.  Christley,  Harry  B.  Henderson,  Hartje 
.    Building.  Wood  St.  and  First  Ave.,  Pittsburgh. 


District  No.  6 


(22) 


